title: Evaluation and management of the premenopausal woman with low BMD.
abstract: Interpretation of bone mineral density (BMD) results in premenopausal women is particularly challenging, since the relationship between BMD and fracture risk is not the same as for postmenopausal women. In most cases, Z scores rather than T scores should be used to define "low BMD" in premenopausal women. The finding of low BMD in a premenopausal woman should prompt thorough evaluation for secondary causes of bone loss. If a secondary cause is found, management should focus on treatment of this condition. In a few cases where the secondary cause cannot be eliminated, treatment with a bone active agent to prevent bone loss should be considered. In women with no fractures and no known secondary cause, low BMD is associated with microarchitectural defects similar to young women with fractures; however, no longitudinal data are available to allow use of BMD to predict fracture risk. BMD is likely to be stable in these women with isolated low BMD, and pharmacologic therapy is rarely necessary. Assessment of markers of bone turnover and follow-up bone density measurements can help to identify those with an ongoing process of bone loss that may indicate a higher risk for fracture, and possible need for pharmacologic intervention.
authors.affiliation: Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8-864, 630 West 168th St, New York, NY, 10032, USA, ac1044@columbia.edu.
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D015519:Bone Density / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D010024:Osteoporosis / Q000517:prevention & control*; D017697:Premenopause / Q000502:physiology*
chemical_list: D050071:Bone Density Conservation Agents